Seminar on

Oxygen

insufficiency

SL.NO CONTENT I.

II. III.

IV.

V.

INTRODUCTION

CONTENT

Oxygen Insufficiency

a) Defintion b) Signs and symptoms of oxygen insufficiency c) Etiology for oxugen insufficiency d) Factors affecting oxygenation e) Disease which occurs due to oxygen insufficiency

1. Hypoxemic respiratory failure or oxygen failure 2. Chronic respiratory insufficiency 3. Hypoxia 4. Hypoxemia 5. Anoxia 6. Renal failure 7. Cyanosis 8. Clubbing of fingers 9. Cerebral palsy

10.Ischemic heart disease 11.Syncope f) Diagnostic evaluation g) Management of the patient who is having oxygen insufficiency h) Prognosis of the patient those who are affected with oxygen insufficiency i) Nursing diagnosis and intervention CONCLUSION

SUMMARY

BIBLIOGRAPHY

INTRODUCTION

Oxygen is essential to life. Al cells in the body requires it, some being

more sensituve to a lack of oxygen than others. The nomal amount of oxygen

in the external blood shoud be in the range of 80 – 100 mm hg. If it falls below

60 mm hg, irreversible physiologic effects may occur. Oxygen administration

helps to treat the oxygen insufficiency.

MEANING OF OXYGEN

A colourless, odourless gas constituting one fifth of the atmosphere.

21% of oxygen present in the atmospheric air.

DEFINITION OF OXYGENATION

Oxygenation is a process which occurs in the lungs to the haemoglobin

of blood, which is saturated with oxygen to form oxyhaemoglobin.

MEANING OF OXYGEN INSUFFICIENCY

Suffiecient amount of oxygen is not getting the organs to maintain their

functions.

ETIOLOGY

Decreased haemoglobin & oxygen carrying capacity of blood.

Diminshed concentration of inspired oxygen which may occur at high

attitude.

Inability of the tissue to extract oxygen forms the blood in case of

cyanide poisoning.

Decreased diffusion of oxygen from the alveoli to the blood as with in

pneumonia.

Poor tissue perfusion with oxygenated blood as with shock.

Impaired ventication as with multiple rib fracture or chest traumas.

SINGNS AND SYMPTOMS OF OXYGEN INSUFFICIENCY

Anxious and tired

Headache, dizziness, irritability and memory loss.

Nausea, vomiting and cyanosis

Oliguria and anuria

Fatigue lethargic

RBC count increases, 1 tb concentration increase

Clubbing of fingers

Sometime patient may have pain while breathing

FACTORS AFFECTING OXYGENATION

1) ENVIRONMENTAL FACTORS:

Environmental can influence oxygenation. The incidence of

pulmonary disease is higher in emoggy, urban areas than in rural areas.

The client’s work place may increase the risk for pulmonary disease.

Occupational pollutants include asbestos, talcum powder, dust and

airborne fibres.

Asbestosis in an occupational lung disease that develops after

exposure to asbestos. The lung is asbestosis is characterised by diffuse

interstitial fibrosis, creating a restrictive long disease.

Clients at risk for developing asbestos include those working with

textiles fire proofing or milling or in the production of paints, plastics or

some prefabricated construction.

Client exposed to asbestos who also have the habits of smoking

means increased risk of developing lung cancer.

AIR POLLUTION IS AN IMPORTANT FACTOR THAT EFFECT THE

OXYGENATION

SOURCES OF AIR POLLUTION

a) AUTOMOBILES

Motor vechiles are a major source of air pollution throughout the

urban areas.

b) INDUSTRIES

Industries emit large amount of pollutants into the atmosphere.

c) DOMESTIC SOURCES

Domestic combustion of coal, wook or oil is a major source of

smoke, dust, and sulphur dioxide and nitrogen oxide.

d) MISCELLANEOUS

Burning refuse, incinerators, pesticide spraying, nuclear energy

programme and also natural sources (bacteria)

HEALTH ASPECTS

The health effects of air pollution are both immediate and delayed. Immediate

effects are borne by the respiratory system, resulting state is acute bronchitis.

If the air – pollution is intense, it may result even in immediate death by

suffocation.

2) PHYSIOLOGICAL FACTORS

1. DECREASED OXYGEN – CARRYING CAPACITY

Hhaemoglobin carries 99% of the oxygen tissues. Anaemia and

inhalation of toxic substances decreases the oxygen – carrying

capacity of blood, by reducing the amount of availabe

haemoglobin to transport oxygen. Anaemia lower than normal

haemoglobin level is a result of decreased haemoglobin

production, increased red blood cell destruction and blood loss.

Clients will have complaints of fatigue, decreased activity

tolerance and increased breathlessness as well as pallor and an

increased heart rate.

2. DECREASED INSPIRED OXYGEN CONCENTRATION

When the concentration of inspired oxygen declines, the oxygen

carrying capacity of the clood is decreased. It may lead to

respiratory problems.

3. INCREASED METABOLIC RATE

Increased metabolic activity cause, increased oxygen demand.

When body systems are unable tomeet this increased demand the

level of oxygenation decliens.

DEVELOPMENT FACTORS

INFANTS AND TODDLERS

Infants and toddlers are at risk for upper respiratory tract infection as a

result of frequent exposure to other children and exposure to secondhand

smoke.

SCHOOL AGE CHILDRES AND ADOLESENTS

School age childrens and adolescents are exposed to respiratory

infection and respiratory risk factors such as second hand smoke and

cigarette smoking.

YOUNG AND MIDDLE – AGE ADULTS

Young and middle age adults are exposed to multiple caridopulmonary

risk factors such as unhealthy diet, lack of exercise, stress, illegal drugs,

smoking and unhealthy lifestyle.

OTHER ADULTS

Ventilation and transfer of respiratory gases dicline with age, because

the lungs are unable to expand fully, leading to lower oxygenation levels.

LIFESTYLE RISK FACTORS

NUTRITIONAL FACTORS

Severe obesity decreases lung expansion.

The increased body weight increases oxygen demands to meet

metabolic need.

Malnourished (child) client may experience respiratory muscle wasting

resulting in a decreased muscle strength and respiratory excursion.

Diet high in fat increase cholestrol and atherogenesis, artheroscienosis

in the coronary arteries.

Client who are morbidly obese and malnourished are at risk for

anaemia.

MEDICATIONS

Many medications affect the function of the respiratory system. Patients

receiving drugs that affect the central nervous system need to be

monitored carefully for respiratory complications. For example, opioids are

chemical agents that depress the meducary respiratory center. As a result

the rate and depth of respiration decrease. The nurse must be alert fo the

possibility of respiratory depression or arrest when administering any

narcotic or sedative.

PHYSIOLOGICAL HEALTH

Many physiology factors and conditions can affect the respiratory

system. Individuals responding to stress may sigh exessively or exhibit

hyperventilation (increased rate and depth of ventilation, above the body’s

normal metabolic requirement). Hyperventilation can lead to a lower level

of arterial carbon dioxide. Generalized anxiety has been shown to cause

enough bronchospasm to produce an episode of bronchial asthma. In

addition patient, with respiratory problem often develops some anxiety as

a result of the hypoxia caused by the respiratory problem.

LEVELS OF HEALTH

Acute and chronic illness can dramatically affect a person’s respiratory

function. For example, people with renal or cardiac disorders often have

compromised respiratory functioning because of fluid overload and

impaired tissue perfusion. People with chronic illness often have musle

wasting and poor muscle tone. These problems affect all the muscles,

including those of respiratory system. Alterations in muscle function

contribute to inadequate pulmonary ventilation and respiration.

Myocardial infarction (heart attack) causes a lack of blood supply to

heart muscle. Damage to muscle interferes with effective contraction of the

muscle, leading to decreased perfusion of tissue and decreased gas

exchange.

Physical changes such as scoliosis (curvature of the spine) influence

breathing pattern and may cause air trapping.

EXERCISE

Exercise increase, the body metabolic activity and oxygen demand rate

and depth of the respiratory increase enabling the person to inhale more

oxygen and exhale excess carbon dioxide.

People who exercise for one hour daily have a lower pulse rate, blood

pressure, decreased cholesterol level, increased blood flow and greater

oxygen extraction by working muscles.

SMOKING CESSATION

Inhaled nicotine cause vasoconstriction of peripheral and coronary

blood vessels increasing blood pressure and decreasing blood flow to

peripheral vessels. The risk of lung cancer is 10 times greater for a person

who smokes than for a non smoker. Explosure to second hand smoke

increase the risk of lung cancer and cardiovascular disease in th enon

smoker.

SUBSTANCE ABUSE

Excessive use of alcohol and other drugs can impair tissue oxygenation

in two ways. The person who chronically abuses substances often has a

poor nutritional intake.

Second: - excessive use of alchohol and certain other drugs can depress

the respiratory center, reducing the rate and depth of respiratory and th

amount of inhaled oxygen.

Substance abuse ny either smoking or inhalation such as crack cocaine

or inhaling fumes from paint or glue cans cause direct injury to lung tissue

that can load to permanent lung damage and impaired oxygenation.

STRESS REDUCTION

A continuous state of stress or severe anxiety increases the body’s

metabolic rate and the oxygen demand. The body responds to anxiety and

other stresses with in an increased rate and depth of respiration.

DISCASE WHICH OCCURS DUE TO OXYGEN INSUFFICIENCY

MUSCULOSKELETAL ABNORMALITIES

Musculoskeletal impairements in the thoracic region reduce

oxygenation. Such impairements may result from abnormal structural

configuration, trauma, muscular diseases and disease of central nervous

system.

Abnormal structural configuration imparting oxygenation include those

that affect the rib cage, such as pectus excavatum and those that affect the

vertebral column such as kyphosis, tordusis or scolliosis.

TRAUMA

The person with multiple rib fracture can develop a fail chest, a

condition in which fractures cause instability in part of the chest wall. The

instable chest wall allows the lung underlying the injured area to contract

on inspiration and bulge on expiration, resulting in hypoxia.

NEUROMUSCULAR DISEASES

Disease such as muscular clystrophy affects oxygenation of tissue by

decreasing the client’s ability to expand and contract the chest wall.

Ventilation is impaired an atelectasis, hypercapnia and hypoxemia can

occur.

CENTRAL NERVOUS SYSTEM ALTERATIONS

Disease or trauma involving the medulla oblongata and spinal cord may

result in impaired respiration. When the medulla oblongata is affected

neural regulation of respiration is damaged and abnormal breathing

patterns may develop. If the phrenic nerve is damaged, the diaphragm may

not descent, thus reducing inspiratory lung volume and causing hypoxia

medulla in lung volume and causing hypoxia medulla in the brain stem

immediately above the spinal cord is the brain stem immediately above the

spinal center.

MYOCARDIAL ISCHEMIA

When blood supply to the myocardium from the coronary arteries is

insufficient to meet the oxygen demand of the organ two common

manifestations of this ischemia are angina pectoris and myocardial

infarction.

Angina pectoris is usually a transient imbalance between myocardial

oxygen supply and demand. The pain can last for 1 to 15 minutes. Chest

pain may be left sided or substernal and my radiate to the left or both arms

and to the jaw, neck and back.

Myocardial infraction (MI) sudden decrease in coronary blood flow or

an increase in myocardial oxygen demand with out adequate coronary

perfusion. Infarction occurs because of ischemia and neurosis of

myocardial tissue.

HYPOVENTILATION

It occurs when alveolar ventilation is inadequate to meet the body’s

oxygen demand or to eliminate sufficent carbon dioxide.

HYPOXIA

Hypoxia is inadequate tissue oxygenation at the cellular level. This can

result from a deficiency in oxygen delivery or oxygen utilization at he

cellular level.

CYANOSIS

Blue discoloration of the skin and mucous membrane caused by the

presence of desaturated hemoglobin in capillaries is a late sign of hypoxia.

CEREBRAL PALSY

Cerebral palsy is a non-progressive neurological disorder that is present

from birth and ususally invloves motor function. Common cause imclude,

hypoxia or ischemia during labour and birth but a substantial number of

cases are caused by factors occuring during intrauterine life.

SYNCOPE

Temporary loss of consciousness, feeling faint. It may indicate

decreased cardiac output, fluid deficit or defects in cerebral perfusion.

Synlope frequently occurs as a result of postural hypotension. When the

patient is ambuiates. It is more common in older adult or in the patient

who has been immobile for long period of time. Normally when the patient

quickly moves to a standing position.

DIAGNOSIS EVALUATION OF THE PATIENT THAT WHO IS

HAVING OXYGEN INSUFFICIENCY

A. HISTORY COLLECTION

Nursing history should focus on the clients ability to meet

oxygen needs. Nursing history for cardiac function includes pain,

dyspnea, fatigue, peripheral circulation, cardia risk factors, presence

of past or current conditions.

Nursing history for respiratory function includes the presence

of a cough, shortness of breath,wheezing, pain environmental

exposure, frequently of respiratory tract infections, past respiratory

problem, current medications use and smoking history or second

hand smoke exposure.

PHYSICAL EXAMINATION

INSPECTION

At first nurse has to performe a head to toe observation of the client for

skin and mucous membrane, general appearance level of consciousness,

breathing pattern and chest wall movement any abnormalities should be

investigated during palpation, percussion and ausculation.

Inspection includes observation of the nails for clubbing. Clubbed nails,

obliteration of the normal angle between the use of the nail and the skin, are

seen in clients with prolonged oxygen deficiency endocarditis and congenital

heart defects.

Inspect the chest contour and shape. Normally the adult chest contour is

slightly convex with no sternal depression, the anteroposterior diameter

should be less that the transverse diameter. Note the anteroposterior

diameter of the chest wall conditions such as empty sema, advancing age and

copd cause the chest to assume a rounded shape.

PALPATION

Palpation of the chest provides assessment data in several areas. It

documents the type and amount of thoracic excursion, elicit andy areas of

tenderness and can identify tactile fremitose the capacity to feel sound on the

chest wall by placing your plam to the patients chest wall, avoiding boney

areas. Ask the patients to repeat some nulti – syllable word (eg: “ninenty –

nine”) and feel for the vibration. Normally the vibrations are equal bilaterally

in different areas on the chest wall. The greatest intensity is noted at the

anterior and posterior base of the neck and along the tranchea and large

bronchi. Increased fremitus occurs inpatient with pneumonia because solid

tissue conducts sound well conversely; patients with copd have decreased

fremitus because air does not conduct sound as well. Note the presence or

absence of masses, edema or tenderness on palpation.

PERCUSSION

Percussion allows the nurse to detect the presence of abnormal fluid or

air in the lungs. It also used to determine diaphragmatic excursion.

AUSCULTATION

Auscultation enables the nurse to identify normal and abnormal heart

and lung sounds. Auscultation of the lung sound involves listening for

movement of air throughout all lung fields. Anterior, posterior and laternal.

Adventitious breath sounds occur with collapse of a lung segment, fluid in a

lung segment ar narrowing or obstruction of an airway.

COMMON DIAGNOSIS TESTS

a. PULMONARY FUNCTION TEST

It helps to determine the ability of the lungs to efficiently exchane and carbon

dioxide.

MEASUREMENT NORMAL

RANGE

CLINICAL SIGNIFICANCE

Tidal volume (Vt) Volume of air inhaled or exhaled per breath. Residual volume (Rv) Voulme of air left in lungs after a maximal exhalation. Functional residual capacity Volume of air left in lungs after a normal exhalation.

5-10 ml/kg 1000 – 1200 ml 2000 – 2400 ml

Decreased in restrictive lung disease and older client. Increase in clients with copd and older clients due to decreased respiratory muscle mass, strength, elastic recoil and chestwall compliance. Increased in clients, with copd and older clients due to decreased respiratory muscle mass, strength, elastic recoil and chestwall compliance.

MEASUREMENT

NORMAL

RANGE

CLINICAL SIGNIFICANCE

Vital capacity(Vc) Volume of air exhaled after a maximal inhalation Total lung capacity(TLC) Total volume of air in lungs following a maximal inhalation

4500 – 4800 ml 5000 – 6000 ml

Decreased in pulmonary edema a telectusis and changes associated with a giving. Decreased in restrictive lung disease increase in obstructive lung disease.

PEAK EXPIRATORY FLOW RATE (PEFR)

The point of highest folow during moximal expiration. Normal is based

on age and body weight. It is routinely used for patients with moderate or

severe asthma to measure the severity of the disease and degree of disease

control.

ARTERIAL BLOOD GAS

Measures the hydrogen concentration partial pressure of carbon

dioxide, partial pressure of oxygen, oxygen concentration.

SPIROMETRY

Spirometry measure, the volume of air in liters exhaled or inhaled by a

patient over time.

PULSE OXIMETRY

It is a noninvasive technique that measures the arterial oxyhaemoglobin

satruation of arterial blood. It is useful for monitioring patients receving

oxygen therapy, litrating oxygen therapy, monitoring those at risk for hypoxia

and post operative patients. A range of 95% to 100% is considered normal

spo2; values less than 85% indicate that oxygentation to the tissue is

inadequate.

CHEST X – RAY

Usually posteranterior and lateral films ar etaken to adequately

visualtize all of the lung fields. Radiography of the thorux is used to observe

the lung field for fluid (pneumonia), masse (lung cancer), other abnormal

process.

BRONCHOSCOPY

Visual examination of the tracheobronchial tree through a narrow,

flexible fiberoptic bronchoscope. Performed to obtain fluid, sputum or biopsy

samples, remove mucous plugs or foreign bodies.

THORACENTESIS

Thoracentesis is a surgical procedure of puncturing the chest and

aspirating pleural fluid, for diagnostic or therapeatic purposes or to remove a

specimen for biopsy. The procedure is performed using aseptic technique and

local anesthesic. The client usually sits upright with the anterior thorax

supported by pillows or an over – bed table.

SPUTUM SPECIMENS

Obtained to identify a specific micro – organs. Organism growing in the

sputum identify drug resistance and sensitivities

THROUT CULTURE

It determines the presence of pathogenic organisms. Positive results are

used to determine the correct antibiotic. For treatment based on the organism

cultured.

MANAGEMENT

1. POSITION

Semi fowler’s or fowler’s allows maximum expansion. Pysgenic

patients often assume orthopaedic position sit in need and lean over

bed tables, usually with a pillow for support.

2. BREATHING EXERCISES

DEEP BREATING EXERCISES

When hypoventilation occur a decreased amount of air enters and

leaves the lungs. However deep – breathing exercises can be used to

overcome hypoventilation.

ABDOMINAL AND PURSED LIP BREATHING

a) Assume comforatble semisitting position in a bed or chair or a lying

position I bed with one pillow.

b) Flex your knees to relax the muscle of abdomen.

c) Place one or both hands on your abdomen just below the ribs.

d) Breathe in deeply through the nose keeping the mouth closed.

e) Concentrate on feeling or skin and tighter the abdomen muscle

breathing out to enhace effective exhalation.

f) If indicated, cough two or more time during exhalation.

g) Use this exercise whenever feeling short of breath and increase

gradually to 5 – 10 minutes a day.

3. NEBULISATION

Nebulisation is a process of adding moisture or medication to

inspired air by mixing particle of varying sizes with air.

PURPOSE

a. To relieve respiratory insufficiency due to broncho spasm.

b. To correct the underlying respiratory disorder responsible broncho

spasm.

c. To liquefy and remove retained thick secretion form the lower

respiratory tract.

d. To reduce inflamatory and allergic response in the upper respiratory

tract.

e. To correct humidity deficit.

TYPES

1. JET NEBULISER

The jet nebulisier utilises a high velocity gas flow, to generate

particel from the presecribed solution either oxygen or

compressed air power the nebulizer.

2. ULTRA SONIC NEBULIZER

It utilise fluid contained a chamber which is rapidly vibrated

causing the fluid to break into particle.

CHEST PHYSIOTHERAPY

Chest physiotherapy is a group of therapies used in combination t

mobilize pulmonary secretion. These therapies include postural drainage,

chest percussion and vibration. Chest physiotherapy should be followed by

productive coughing and suctioning of the eclient who has a decreased ability

to cough.

Positional drainage is use of positioning technique that draw secretions

form specific segments of the lungs and bronchi in to thr trachea. Coughing or

suctioning normally removes secretion from the trachea.

Chest percussion involves striking the chest wall over the area being

drained the hand is positioned so that finge and thumb touch and the hands

are cupped. Chest percussion is performed by striking the chest wall

alternatively with cupped hands.

SUCTIONING

The suctioning technique includes oropharyngeal and nusopharyngeal

suctioning. Orotracheal and naso tracheal suctioning and sanctioning

secreation should perform after suctioning of the oropharynx trachea, by

using a rounded – tipped catheter.

OXYGEN THERAPY

OXYGENATION BY APPLYING NASAL CANNULA

A nasal cannula is a simple, comfortable device for delivering oxygen to

a client. The two tips of the cannula about 1.5 cm long proturole form a centre

of a disposable tube an dare inserted into the nostrils. Oxygen is delivered via

the cannula with a flow rate of 5 – 6 liter / minute.

OXYGENATION BY APPLYING AN OXYGEN MASK

An oxygen mask is shaped to fit snugly over the client’s mouth and nose

and is secured in place a strap. Th e two primary type of mask are the high

and low concentration ozxygen mask. Oxygen concentration of 21% to 56%

may be delivered.

NASAL CATHETER

A nasal or oropharyngeal catheter is another efficient means for

adminstering oxygen, but it is infrequently used because it is uncomfortable

for the patient and may cause trauma to respiratory mucous membrane.

OXYGEN TENT

Oxygen tent is a light, portable structure made of clear plastic and

attached to a motor driven unit. The motor helps to circulate and cool the air

in the tent.

OXYGEN THERAPY IN THE HOME

Liquid oxygen and oxygen concentration rather than cylinders are used

more commenly in the home setting. Liquid oxygen is kept inside a small

thermal storage tank kept in the home. An oxygen concentration removes

nitrogen form the room air and concentrates the oxygen left in the air oxygen

concentration is portable, cost effective and easy to use but cannot deliver

oxygen flow at greater than 4 lit / min.

NURSING DIAGNOSIS AND INTERVENTIONS

Impaired gas exchange related to broncho construction and

inflammation of airways.

Ineffective airway clearance related to increased mucous production

due to upper respiratory infection and asthma.

Anxiety related to difficulty in breathing as manifested by asking more

doubts.

Inffective breathing pattern related to neuromuscular impairement of

respirations (pain, anxiety, decreased level of consciousness,

respiratory muscle, fatigue and bronchospasm.) as evidenced by altered

respiratory rte.

Fluid volume deficit related to sodium and water retension as

manifested by crackles.

Imbalanceed nutrition less than body requirement related to poor

appetite, shortness of breath, decreased energy level and increased

caloric requirement as evidenced by weight loss, weakness, muscle

waiting.

NURSIN G INTERVENTIONS

Impaired gas exchange related to broncho construction and

inflammation of airways

Monitor pure oximetry every 4 hrs.

Monitor and evaluate vital sign ever 4 hrs.

Maintain patient in position of comfort.

Evaluate effectiveness of albuterol nebulizer treatments.

Auscultate lung every 4 hrs.

Ineffective airway clearance related to increased mucous production

due to upper respiratory infection and asthma

Encourage and instruct in coughing and pursed lib breathing

techniques.

Monitor effectiveness of bronchodilators in increasing

expectoration of secretions.

Note characteristics of sputum.

Evaluate respiratory rate and effort.

Encourage increased fluid intake.

Auscultate breath sounds every 4 hrs.

Anxiety related to difficulty breathing as manifested by asking more

doubts.

Assess the level of anxiety.

Provide calm reassuring presence.

Utilize therapeutic touch.

Keep patient and family informed of actions taken to improve

breathing.

Use brief, simple explanation.

Maintain quiet, calm environment.

Encourage pursed lip breathing to manage dyspnea.

JOURNAL ABSTRACT

1. A study conducted by Norman .R. Kreisman, Thomas .J. Sick and Myron

Rosenthal in1983 of “Important Of Vascular Responses In

Determining Contical Oxygenation During Recurrent Paroxysmal

Events Of Varying Duration And Frequency Of Repetition”. Through

this study they state that continuous measurements were made of local

changes in cortical blood volume, redox levels of cytochrome article PO2

and sustamatic arterial blood pressure during recurrent seizure induced

by pentylenetetrazol or brcuculline. In contrast to expectations,

systemic and cerebral valscular responses and associated increases in

cerebral oxygenation were better maintaining during long duration ictal

episodes than during shor – duration ictal bursts, interictal spikes or

evoked potential short – duration paroxysmal events were often

accompanied by decreases in cerebral oxygenation whereas long

duration events where skills accompanied by increases in oxygenation.

Ictal bursts occuring with short interburst intervals caused a more rapid

failure of vascular responsiveness than those occuring at longer

intervals. These relations of intensity and frequency of repetition of

seizures to change in vascular responses indicate progressive

disassociation of the normally tight couple between neuronal activity

energy demand and cerebral blood flow during status epilepticus.

2. A study conducted by bertin germany I 2007 “oxygen insufficiency as

determining factors in stroke” published in th ejournal of molecular

medecine. Publishers are Springer – verlag, volume - 85 issue- 12; Page

no: 1331 – 1338.

Through this study the brain demands oxygen and glucose to

fulfill its role as the master regulator of body functions as diverse as

bladder control and creative thinking. Chemical and electrical

transmission in the nervous system is rapidly distrupted in stroke as a

result of hypoxia and hypoglycemia. Despite being highly evolved in its

architecture, the human brain appears to utilize phylogenetically

conserved homeostatic strategies to conbat hypoxia and ischemia

specifically, several converging lines of inquiry have demonstrated that

the transcriptionfactor hypoxia – inducible factor mediates the

activation of a large cassette of genes involved in aduptation to hypoxia

in surviving neurons after stroke.

3. Lawerence.M.Agius conducted a study in (2006) on “Dynamic of the

pneumbral zone in neuronal ischemia and prosoruival “ published in the

international Journal of molecular medecine and advane science.

Volume -2 , page no: 84 – 89.

Through this study; the prosence of a core of ischemia necross in

cerebral tissue would determine evolving mechanisms in the penumbral

zone determining pathology and clinical sterilization of progessive

neuronal would constitue one expresson of many in a vascular occlusive

series of phenomenon associated with progression or non progression

of such neuronal injury. Active tissue participation may develop in

directly and indirectly induced cell injury and cell death as either

necrosis or apoptosis. Indeed, a central role for tissue vascularity might

perhaps determine either cell apoptosis or necrosis in ischemia events

of progression or non progression.

4. Rishu Piao, Hedehino conducted a study in (2005) on “Oxygen

insufficiency compensated during acute ischemia? A pet study in an

ischemia model of non – human primates.” Published in the Journal of

cerebral blood flow and metabolism.

Through this study they reveal that in acute ischemia regions

there is little response in vasculature and that change is diffusion.

Efficiency of oxygen doesnot act as a compensatory response rather

passively depends on the metabolic demand although oxygen extraction

fraction is increased. The findings idicate that brain tolerance for

oxygen insufficiency is not so large that oxygen metabolism during

ischemia con – related final tissue outcome.

5. A study conducted by Samuel .N. Heyman on “Regional alterations in

renal haemoglobin and oxygenation a role in contract medium –

induced nephropathy” published in oxford Journal volume – 20; page

no: 6 – 11.

Through this study they state that most clinical risk factors for

contrast nephropathy are characterized by predisposition to medullary

oxygen insufficiency by co – existing vasoconstrictive stimuli, by

enhanced transport workload or by structurally altered

microcirculation. Under such predisposing conditions, regional hypoxia

stress may intensify and supress the capacity for the generation of

adaptive responses, evolving into adoptotic or necrotic tubullar cell

death, associated with renal dysfunction. Amelionation of medullary

hypoxic stress should be taken into account when designing strategies

to prevent or atenvate contrast media induced nephropathy.

BIBLIOGRAPHY

A. BOOK BIBLIOGRAPHY

1. Chintamani (2011) “Lewis’s medical surgical nursing” published by

Elsevier a division of need Elsevier india private limited page no

1751.

2. Suzanne .C. Smeltzer, Brenda Bare (2004) “Brunner & Suddarth’s text

book of medical surgical nursing” published by lippincott williams

and wilkins 10th edition. Page no 577, 600,601.

3. Potter and Perry (2005) “Fundamental sof nursing” publised by most

by an imprint of Elsevier, 6th edition. Page no 1068 – 1071.

“Fundamentals of nursing the art and science of nursing care” 6th

edition volume 2, published by wolters kluwer india private limited

New Delhi.

4. Dugas (2006) “Introduction to patient care a comprehensive

approach to nursing” 4th edition, volume published by elsevier New

Delhi. Page no 371 - 395.

B. JOURNAL REFERENCE

1. Norman .R. Kreisman Thomas .J.Sick and Myron Rosenthal

(1983) “Journal of cerebral blood flow & metabolism”, “ Importance

of vascular responses in determining cortical oxygenation during

recurrent paroxysmal events of varying duration and frequency of

repetition” volume – 31. Page no: 330 – 338.

2. Berin Germany (2007) “Journal of molecular medecine” publishers

springer – verlage “Oxygen insufficiency as determining factor in

stroke” volume 85. Issue -12, page no: 1331 – 1338.

3. Lawernce .M>Agius (2006)”International Journal fo molecular

medecine and advance science” interactive dynamics of the

pneumbral zone in neuronal ischemia and propuruival” volume – 2.

Page no 84 – 89.

4. Rishu Piao, Hedihiro Lida (2005) Journal fo cerebral blood flow and

metabolism “ Is oxygen insufficiency compensated during acute

ischemia? A pet study in an ischemia model of non – human

primates.

5. Samuel .N.Heyman, “regional alterationsin renal haemoglobin and

oxygenation a role in contrast medium – induced nephropathy”.

Oxford journal volume – 20, page no i6 – i11.